Chapter 411

Since coming to this era, Hu Xiaotian has already performed surgery more than once; to him, an appendectomy presents no difficulty at all. Although he had hesitated a bit because of Long Yelin's status, once he decided to operate on him, Hu Xiaotian quickly calmed down. How is the Emperor? The Emperor is also a patient; to perform a successful surgery, one must forget the patient's identity and simplify the relationship—no ruler and subject, no high or low, noble or base—I am the doctor, you are the patient, that's all.

Hu Xiaotian sought Li Yifeng in order to obtain surgical instruments from him; the first surgery Hu Xiaotian ever performed was carried out with the help of Yiyuantang. Later, Li Yifeng specially, according to the diagrams Hu Xiaotian provided, sought Dakang's foremost workshop—the Heavenly Workshop—and crafted a complete set of surgical instruments. Before Hu Xiaotian went to Qingyun to take office, he also gave him a set as a gift, but that set of instruments was lost when he left Qingyun.

Hu Xiaotian asked Li Yifeng, and Li Yifeng indeed still had a set, so he hastily sent someone to Yiyuantang to fetch the instruments.

In modern surgery, appendectomy is best performed with lumbar or epidural anesthesia. Of course, local infiltration anesthesia can also be used; given the current medical conditions, only local anesthesia is feasible.

Li Yifeng provided the anesthetic from Yiyuantang, but his anesthetic seemed ineffective on the Emperor; after internal and external application, Long Yelin's pain did not lessen much.

Performing surgery inside the Imperial Palace is far superior to doing so under civilian conditions. Following Hu Xiaotian's request, Xuanweigong was temporarily converted into an operating room, and all idle personnel were dismissed. The surgical area was given a simple disinfection, and then Long Yelin's body surface skin was disinfected with strong liquor.

The preparations went fairly smoothly, but the anesthetic's effect remained poor; Long Yelin groaned in pain, his tolerance truly terrible, which made Hu Xiaotian anxious. He quietly called Ji Feihua aside and whispered, 'Commander, do you have any way to ease the Emperor's pain?'

Ji Feihua replied calmly, 'You are a doctor. Zajia knows nothing about medicine.'

Hu Xiaotian then had another idea: 'Let the Emperor sleep for a while; that would work too.'

Ji Feihua nodded and said, 'This is simple.' He went to the side of the dragon bed and tapped Long Yelin's sleep-inducing acupoint; Long Yelin indeed drifted into a drowsy sleep. Hu Xiaotian was overjoyed—the biggest problem had been solved, and he could now perform the surgery as he wished.

Hu Xiaotian's surgical instrument diagrams gave Li Yifeng great inspiration; after Hu Xiaotian went to Qingyun to take office, Li Yifeng further refined the instruments he had drawn. All the other imperial physicians had already left, leaving only Li Yifeng as his assistant. Hu Xiaotian donned a mask and headscarf, then picked up a willow-leaf blade.

The two remaining personal eunuchs of the Emperor saw Hu Xiaotian pick up the willow-leaf blade. Their expressions turned extremely fearful; if Hu Xiaotian harbored even a hint of malice and stabbed down, the Emperor would surely meet his doom. They glanced at Ji Feihua, but saw him composed and unperturbed, sitting far away, slowly sipping a cup of clear tea.

Ji Feihua appeared calm, but inside he was still somewhat nervous. His anxiety was not because Hu Xiaotian stood beside the Emperor with a knife; knowing Hu Xiaotian as he did, he knew Hu Xiaotian was a smart man who would not court death, as he himself had just said—even if he disregarded his own life, he still had to consider his parents'. Ji Feihua's unease stemmed from not being certain that Hu Xiaotian could definitely cure the Emperor by opening his abdomen and treating the ailment; this was the first time he had heard of such a procedure.

Hu Xiaotian took a breath, reminding himself to stay calm; it was only a minor surgery, and the patient before him was just an ordinary person.

After his emotions settled completely, reaching a state of no distractions, Hu Xiaotian picked up the surgical knife and made a single incision on Long Yelin's abdomen. The two eunuchs watching from behind could no longer bear to look and hastily turned away.

Hu Xiaotian used a right lower oblique incision; this type of incision crosses the muscles, making healing relatively strong and less prone to incisional hernia. Moreover, it lies close to the appendix, facilitating its location. The incision is usually under two inches long; Hu Xiaotian cut decisively, completing the incision in one smooth motion.

After opening the peritoneum, a small amount of exudate and pus seeped out, roughly matching Hu Xiaotian's expectations—not good, but not terrible either. He gestured for Li Yifeng to pick up the homemade aspirator and suction out the cavity's exudate until clean. Li Yifeng then used a retractor to pull the incision open on both sides, and Hu Xiaotian began searching for the appendix.

The key to finding the appendix is to first locate the cecum; the cecum is grayish-white compared to the small intestine, with the taenia coli anteriorly and fat tags on either side. Hu Xiaotian was extremely familiar with human anatomy, so he found the cecum without spending any time at all.

After locating the cecum, he placed gauze under his fingers, pinched the intestinal wall, and gently lifted the cecum; following the taenia coli, he quickly found the appendix.

The appendix showed no adhesions to surrounding tissue; Hu Xiaotian used his fingers to deflect the tip of the appendix toward the incision. Here is a crucial point: regardless of the degree of inflammatory change, one must not clamp the appendix itself with a hemostat or tissue forceps, lest infection spread; instead, one can use a specialized appendix clamp to grasp it, or use a hemostat to hold the mesentery at the appendix's tip and lift it.

The appendix removal should, as much as possible, be performed outside the abdominal wall. Before removing the appendix, its mesentery and the appendicular artery within must be ligated and excised. The anatomy of this true dragon emperor is no different from that of an ordinary person; his mesentery is relatively thin and the relationships are clear. Hu Xiaotian used a hemostat at the root of the mesentery beside the appendicular artery where there were no vessels, punched a small hole, threaded two mulberry-bark threads through, tied a stitch at points about half a centimeter apart vertically, then quickly cut the mesentery, and ligated again near the proximal end.

Having completed this step, Hu Xiaotian wrapped the appendix in a small piece of dry gauze and clamped it with a tissue forceps, then surrounded the base of the appendix's mesentery with saline-soaked gauze around the cecum to prevent intraoperative contamination. He lifted the appendix, and around its base, at a point about half a centimeter from the root on the cecum wall, he performed a purse-string suture, leaving it loose for now. After finishing the suture, he applied a straight hemostat about half a centimeter from the appendix's base to press down, preventing the suture from slipping during ligation. He then tied a mulberry-bark thread at the indentation, clamped the suture near the appendix with a hemostat, cut the thread end with a needle holder, and finally used a straight hemostat to clamp the appendix half a centimeter distal to the suture line; when suturing, he would penetrate the muscular layer but avoid entering the intestinal lumen.

After completing the above steps, the appendix can be excised. With the willow-leaf blade's edge upward, placed directly beneath the clamped straight hemostat gripping the appendix's base, he cut through the appendix, discarding both blade and appendix together. Then he used a hemostat to hold a cotton ball for disinfecting the appendix stump, and discarded the saline gauze protecting the cecum.

The appendix stump still required burial. Hu Xiaotian instructed Li Yifeng: with the left hand, hold a toothless forceps to lift the cecum wall opposite the suture thread's end; with the right hand, hold a hemostat clamping the thread knot, push the appendix stump into the cecal lumen. Simultaneously, Hu Xiaotian lifted and tightened the purse-string suture, burying the stump within the suture's mouth, then ligated and cut the thread end.

The final step is to cover the mesentery and reinforce the closure: using mulberry-bark thread, perform an interrupted figure-eight suture in the submuscular layer about half a centimeter outside the purse-string suture, and fix the appendix's mesentery stump or fat tags to the colon, making the local surface smooth to maximally prevent postoperative adhesions. Before closing the abdomen, clamp a small gauze pad with an oval forceps, insert it into the peritoneal cavity, and check around the cecum for any exudate or pus, or bleeding at ligation points; once confident there is no oversight, proceed to suture each layer of the abdominal wall.

Ji Feihua had originally been sitting there drinking tea, but later he could not help but rise out of curiosity to watch Hu Xiaotian's every move. Experts see the subtleties, laypeople see the excitement; although those assisting Hu Xiaotian were all laypeople, each person recognized from his proficient technique and skill that this fellow possessed superb medical art. Now no one doubts that Hu Xiaotian is talking nonsense; they have begun to believe he truly has the ability to save lives.

The surgery was finished quickly—less than half an hour from start to finish, and the actual cutting time was even shorter. Hu Xiaotian removed his mask, first went to Ji Feihua's side, and smiled, saying, 'The surgery is done.'

'How was it?' In fact, Ji Feihua already knew the result from his expression.

'Fortunately, I did not disgrace the mission!'

Ji Feihua did not immediately release Long Yelin's acupoint; after the surgery ended, Empress Jian rushed in immediately, and upon entering she exclaimed in panic, 'Emperor... Emperor...' and came face to face with Hu Xiaotian.

Empress Jian asked, 'How is the Emperor? Was that blood-sucking worm removed?'

Hu Xiaotian said nothing, merely shaking the tray in his hand before Empress Jian. She saw the bloody, swollen, ulcerated appendix and was so frightened her soul seemed to leave her body; feeling nauseous, she turned and vomited with a 'wa!'

Such a minor surgery as appendectomy allows the patient to sit up the same day. Hu Xiaotian conveyed the postoperative precautions to them, one of which being that they could eat only after passing gas. A group of palace maids and eunuchs, hearing the term 'passing gas,' were completely bewildered, and someone asked, 'What does passing gas mean?'

Hu Xiaotian originally wanted to say that passing gas just meant farting, but saying the Emperor farted seemed overly disrespectful; after some thought, he put it this way: 'In plain terms, passing gas means the Emperor's fart—you must hear the Emperor fart before he can eat.'

A group of palace maids and eunuchs wanted to laugh at his words, but in the presence of the Emperor and Empress, none dared to laugh; they held it in, their faces flushed red, enduring considerable discomfort.

Empress Jian sat beside the bed, seeing that the Emperor still had not awakened, she could not help but worry, asking, 'Why is the Emperor still asleep?'

Hu Xiaotian glanced at Ji Feihua; he was only responsible for the incision, and the Emperor's sleep had nothing to do with him. Ji Feihua had not lifted the acupoint, so the Emperor probably would not wake up anytime soon.

Ji Feihua walked over and gently shook the Emperor's body, saying, 'Your Majesty, wake up!' In fact, he had already silently released Long Yelin's acupoint.

After Long Yelin's acupoint was released, he gradually awoke, opened his eyes, and his first words were, 'I... I am still alive?'

This chapter is a red-packet extra chapter for the wingofgod Alliance, whocool Alliance, and the red-packet extra chapter for Zanzai and Baobao; more will be released in due course! Thanks to all who tipped Zhangyu supporting Zhangyu's brothers and sisters! (To be continued~^~)